Courtesy of the New Zealand Listener - www.listener.co.nz

The organ business

by David W Young

Should there be a trade in body parts?Even in death, commerce's golden arches cannot be avoided. When I kick the bucket, capitalism's soldiers will include a funeral director, possibly an embalmer and all the manufacturers it takes to create a casket, coffin handles, trolleys and grave mats.

One of the few people restricted from doing business over my cooling corpse will be me.

In New Zealand it is illegal to buy or sell human organs. Most organs for transplant are harvested from brain-dead cadavers, although a few come from living donors. In both cases the system relies on voluntary donations.

Unfortunately, New Zealanders are not very giving. We trail behind almost every developed nation in organ donation rates. Grant Kereama's gift of life to Jonah Lomu was as unusual as it was commendable. Since 1993 there have been between 34 and 46 donors a year. Around 350 people need organ transplants, mostly kidneys.

Under the voluntary system, people die waiting. Can business provide a solution?

Most proponents of a market in body organs are economists. To them it is a simple question of demand and supply: when the price of a good is held below its market demand, a shortage develops. Outlawing the sale of organs on the open market holds the price at zero and makes shortage inevitable. The economists point out that we don't rely on charity for the provision of any other necessities of life (food, water and housing) because there would be iniquity and shortages. Two US economists estimate their nation's organ shortage would be resolved with payments of $US1000 to $3000 per donor.

This is what a legitimate market might look like in New Zealand: I enter into a contract with an organ matchmaking agency. If my organs are harvestable when I die (the odds are against this) then my estate receives a payment and some poor sod obtains my abused kidneys, wheezy lungs or dodgy ticker. Separately, trade could be allowed in live donors' organs. That way I could roll up to a clinic today and trade in some bone marrow or a kidney for fast cash.

A common concern is how poor people could afford organs. This is a distribution issue that could be addressed by the government subsidising the distribution of organs where necessary. The alternatives - paying for a lifetime of dialysis, for example - are far more expensive.

Despite its logic, a market in body organs does seem distasteful. It is sad to think that a financial inducement is required to make people act in the interests of others. Yet this doesn't stop the government from providing tax incentives for financial donations to charity.

If we allow our distaste to govern, what options remain? The US attempted a massive publicity campaign to promote voluntary donation. That path is being advocated in New Zealand by www.givelife.org.nz, a heroic effort to promote better organ donation policies spearheaded by the father of a girl suffering from a rare liver condition. It could increase the number of donors, but probably not enough. Even after the US campaign used Michael Jordan to promote donation, the supply of donors remains far below what is needed.

Health Minister Annette King supports four-eight weeks of income support for live organ donors, fixed at 80 percent of an average wage. This is "money for organs" by a different name. It would bring the same ethical drawbacks as an open market - poor people would have a greater incentive to donate organs than the wealthy. But it won't replicate a market's ability to find the right price to end the shortage. King has not proposed any financial reward for organ donations from cadavers.

Perhaps as a society we believe the grubby hands of business should be kept off our organs, especially in death. Maybe we're happy to live in a nation where, thanks to prostitution decriminalisation, we can hire out our bodies for an hour at a time, but can't trade something that would save a life after we have gone.